Today we inter­view Dr. Arthur Lavin, Asso­ciate Clin­i­cal Pro­fes­sor of Pedi­atrics at Case West­ern School of Med­i­cine, pedi­a­tri­cian in pri­vate prac­tice, and one of the first providers of Cogmed Work­ing Mem­o­ry Train­ing in the US (the pro­gram whose research we dis­cussed with Dr. Torkel Kling­berg and Dr. Bradley Gib­son). Dr. Lavin has a long stand­ing inter­est in tech­nol­o­gy-as evi­denced by Microsoft’s recog­ni­tion of his paper­less office- and in brain research and appli­ca­tions-he trained with esteemed Mel Levine from All Kinds of Minds-.

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Key take-aways:

- Schools today are not yet in a posi­tion to effec­tive­ly help kids with cog­ni­tive issues deal with increas­ing cog­ni­tive demands.

AF (Alvaro Fer­nan­dez): Dr. Lavin, thanks for being with us. It is not very com­mon for a pedi­a­tri­cian to have such an active inter­est in brain research and cog­ni­tive fit­ness. Can you explain the source of your inter­est?

AL (Arthur Lavin): Through­out my life I have been fas­ci­nat­ed by how the mind works. Both from the research point of view and the prac­ti­cal one: how can sci­en­tists’ increas­ing knowl­edge improve kids’ lives? We now live in an tru­ly excit­ing era in which sol­id sci­en­tif­ic progress in neu­ro­science is at last cre­at­ing oppor­tu­ni­ties to improve people’s actu­al cog­ni­tive func­tion. The progress Cogmed has achieved in cre­at­ing a pro­gram that can make great dif­fer­ences in the lives of chil­dren with atten­tion deficits is one of the most excit­ing recent devel­op­ments. My col­league Ms. Susan Glaser and I recent­ly pub­lished two books: Who’s Boss: Mov­ing Fam­i­lies from Con­flict to Col­lab­o­ra­tion (Col­lab­o­ra­tion Press, 2006) and Baby & Tod­dler Sleep Solu­tions for Dum­mies (Wiley, 2007), so I not only see myself as a pedi­a­tri­cian but also an edu­ca­tor. I see par­ents in real need of guid­ance and sup­port. They usu­al­ly are both very skep­ti­cal, since they have been promised too many things too many times by “experts”, yet open-mind­ed to ideas with good foun­da­tions. Many pro­fes­sion­als have only the skep­ti­cal frame, since they were edu­cat­ed when sci­en­tists still believed the brain was pret­ty rigid and “untrain­able”. We need much more brain sci­ence-based pro­fes­sion­al devel­op­ment, and appre­ci­ate the great work Sharp­Brains is doing.

AF: Let’s talk about that “train­abil­i­ty” and schools. Most peo­ple still think of “intel­li­gence” as fixed. Now, I recent­ly read a report on how KIPP schools empha­size the train­ing on some basic skills, such as shared atten­tion, as a need­ed foun­da­tion for good aca­d­e­m­ic per­for­mance. So, even if lim­it­ed in scope, it seems some schools are start­ing to under­stand their role in cog­ni­tive devel­op­ment. In your expe­ri­ence, are schools ful­fill­ing their roles as brain gyms, places where young minds get shaped and ready for life?

AL: Good ques­tion. I have been a pedi­a­tri­cian work­ing with schools in the Cleve­land area since 1985, seen all kinds of dis­eases. For exam­ple, I have wit­nessed the grow­ing inci­dence of autism spec­trum dis­or­ders, such as autism and Asperger’s. I have also observed how school work has increas­ing­ly become more cog­ni­tive­ly demand­ing, start­ing from kinder­gar­den. There is too much pres­sure today, and a grow­ing num­ber of prob­lems, yet I don’t see that schools are apply­ing the best knowl­edge of how minds work. Just as doc­tors offices are cen­ters of applied med­ical sci­ence, tak­ing the lat­est advances in med­ical research and apply­ing them to the med­ical care of peo­ple, schools should be the best place for applied neu­ro­science, tak­ing the lat­est advances in cog­ni­tive research and apply­ing it to the job of edu­cat­ing minds. Yet, they aren’t, and I can’t blame them , giv­en the wide vari­ety of pres­sures they work under, and the large change in per­spec­tive becom­ing insti­tutes of applied neu­ro­science would take.

A cog­ni­tive gap?

AF: Some read­ers may be skep­ti­cal of the claim that school work is more demand­ing today than, say, 20 years ago. They may say kids are sim­ply becom­ing “lazy”. What do you say to that?

AL: I have nev­er met a lazy kid. All peo­ple want to suc­ceed, in life if not in school. Most chil­dren who strug­gle at school strug­gle might­i­ly to get ade­quate grades. It is true that some are more resilient that oth­ers-if they fail, they will try 10 times hard­er. The ones that are labeled as “lazy” are typ­i­cal­ly ashamed of their lack of capac­i­ty to deal with demands, and resort to an eva­sive strat­e­gy, they try to avoid the whole sit­u­a­tion, run away.

AF: You men­tion a “lack of capac­i­ty to deal with demands”. Is that gap grow­ing? The equa­tion has 2 com­po­nents: capac­i­ty and demands. In terms of capac­i­ty, let me men­tion that recent­ly, the French Edu­ca­tion Min­istry just intro­duced men­tal arith­metic as part of the cur­ricu­lum. I remem­ber, as a kid, spend­ing many hours in the math class where the teacher would require us to per­form a pro­gres­sive­ly com­plex sequence of men­tal cal­cu­la­tions-which is good train­ing for skills such as work­ing mem­o­ry. Mem­o­ry train­ing was impor­tant.

AL: Great point. For exam­ple, years ago we had to mem­o­rize long texts, which, no mat­ter what the con­tent was, was a great way to train and build our atten­tion span, work­ing mem­o­ry, and to devise strate­gies to learn. Today, there are less oppor­tu­ni­ties for such train­ing.

In terms of demands, I can see how com­plex home­work assign­ments are these days even in 3–4rd grade. Kids need to plan and pre­pare a whole matrix of tasks that require good orga­ni­za­tion­al work to com­plete. They need to sequence what they do today, tomor­row, the day after. The major dif­fi­cul­ty, for which such young brains may not be ful­ly ready, is to deal with an over­whelm­ing amount of infor­ma­tion and demands, and exe­cute.

AF: that seems to imply a high­er need for good exec­u­tive func­tions than years ago. A kid needs to have good work­ing mem­o­ry to retain, pri­or­i­tize and sequence much infor­ma­tion into action­able plans, and then exe­cute them, as I had the for­tune to dis­cuss with Mark Katz some months ago. From my pre­vi­ous inter­views with Dr. Kling­berg and Dr. Gib­son, we know that a com­mon prob­lem with many kids with diag­nosed atten­tion deficits is, indeed, work­ing mem­o­ry (the abil­i­ty to hold in mind and manip­u­late sev­er­al units of infor­ma­tion). Can you explain what you see in your work with schools?

AL: I am afraid that many schools are too quick to diag­nose ADD/ ADHD and con­sid­er drugs as the only poten­tial inter­ven­tion. The label itself can be mis­lead­ing and coun­ter­pro­duc­tive. School psy­chol­o­gists have won­der­ful exper­tise in eval­u­at­ing sub­ject-relat­ed prob­lems and describ­ing atten­tion­al deficit symp­to­ma­tol­ogy, but are not trained or asked to com­plete neu­ropsy­cho­log­i­cal pro­files of a child’s cog­ni­tive func­tions. Up to a point, many kids with atten­tion prob­lems would ben­e­fit from edu­ca­tion­al, not med­ical, inter­ven­tions to improve cog­ni­tive func­tions such as work­ing mem­o­ry. I am see­ing it first hand, hav­ing used Cogmed Work­ing Mem­o­ry Train­ing (also called RoboMemo) with 15 pre-screened kids: 80% of them pre­sent­ed a sub­stan­tive improve­ment. With 50%, the results we have seen have been dra­mat­ic.

AF: Please give us some exam­ples, so our read­ers can bet­ter under­stand what work­ing mem­o­ry is and its role in aca­d­e­m­ic per­for­mance and dai­ly life.

AL: Let me give you 3 vignettes, all 3 with diag­nosed atten­tion deficits, who showed clear ben­e­fit not only on cog­ni­tive func­tion­ing but also on AD/HD rat­ing scales.

Patient 1: 11-year-old boy, very impul­sive, even on med­ica­tion. Doesn’t do home­work, con­stant­ly for­gets chores. After the 5-week pro­gram, he is able to sit down and lis­ten instruc­tions, engag­ing in few­er argu­ments with his par­ents. He can do bet­ter men­tal math- for the first time in his life able to do so with­out using his fin­gers. He finds that fol­low­ing school and doing home­work is eas­i­er, grades have improved dra­mat­i­cal­ly.

Patient 2: 16-year-old girl with ADD. She has trou­ble exe­cut­ing home­work, often telling par­ents she had done it when she real­ly hadn’t. Her par­ents thought she liked to lie. Yet, when I talk to her, she is clear­ly more ashamed than dis­hon­est. The work­ing mem­o­ry train­ing pro­gram helps her devel­op a much improved per­cep­tion of time. For exam­ple, she starts to man­age her show­er time bet­ter, being aware of when 5 min­utes have passed-instead of spend­ing 30 min­utes in the show­er, as before. Much improved school work, lying at home has dropped dra­mat­i­cal­ly.

Patient 3: 19-year-old boy in col­lege, who often became par­a­lyzed when he was faced with com­plex chal­lenges. He had a tough time with the cog­ni­tive train­ing pro­gram, but after a while he start­ed learn­ing new strate­gies and devel­op­ing self-con­fi­dence, and show­ing marked improve­ment. Now, he can break com­plex tasks into man­age­able pieces . His atten­tion­al deficits appeared to threat­en his oppor­tu­ni­ties in his fam­i­ly busi­ness. Unable to keep track of change at the cash reg­is­ter, lines at the busi­ness would grow and cus­tomers get angry, leav­ing him out of con­sid­er­a­tion for key start-up employ­ment in the busi­ness. Now he can man­age day-to-day chal­lenges such as these, and the door to being part of the fam­i­ly busi­ness is now open. He can sequence tasks and exe­cute then with a clear plan in mind, with­out being dis­tract­ed and los­ing sight of that plan.

AF: Dr. Lavin, this is all very excit­ing news, that open the way for new inter­ven­tions, new poli­cies, a new under­stand­ing of what “edu­ca­tion” and “learn­ing” is and how to “edu­cate” mil­lions of young minds and equip them for life suc­cess. Thank you very much for your time.

AL: Thank you. I real­ly appre­ci­ate all the work you are doing to bring the lat­est neu­ro­science research and appli­ca­tions to pro­fes­sion­als like me and to par­ents at large.

About SharpBrains

As seen in The New York Times, The Wall Street Journal, BBC News, CNN, Reuters and more, SharpBrains is an independent market research firm tracking health and performance applications of brain science.